Heme Onc + Surgery Part 1 (111-156) Flashcards
1
Q
Endometriosis within uterine wall
A
Adenomyosis
2
Q
Endometriosis within ovary
A
Endometrioma
3
Q
What is the MCV of a microcytic anemia?
A
4
Q
What 2 general reasons can there be for a decreased MCV
A
- decreased HB production
2. Impaired Hb function
5
Q
If you’ve determined that pt has Iron deficiency anemia, whats the NEXT STEP
A
figure out why iron deficient
6
Q
Whats the number 1 anemia in the world?
A
Iron deficiency
7
Q
What’s the number one cause of iron deficiency in the world?
A
Hookworms
8
Q
What population often has increased incidence of Iron deficiency?
A
Women of childbearing age secondary to menses
9
Q
Dx in elderly with iron deficiency
A
Colon cancer until proven otherwise
10
Q
What population has dietary iron deficiency?
A
Children, basically impossible in adults.
11
Q
Reason out why pt with iron deficiency would have following sx:
- tachycardia
- fatigue
- pallor
- smooth tongue
- brittle nails
- esophagel webs
- pica
A
not sure about smooth tongue
12
Q
In Iron deficiency anemia ___ serum iron ___TIBC
A
decreased serum iron
increased TIBC
13
Q
What is on peripheral smear for iron deficiency anemia?
A
Target cells
14
Q
Tx for iron deficiency? Tx goal?
A
iron sulfate - should reach baseline hematocrit within 2 months
15
Q
Ineffective erythropoiesis because of disorder of porphyrin pathway. Dx?
A
Sideroblastic anemia
16
Q
What are 3 causes for sideroblastic anemia?
A
Chronic alcoholism
Drugs (INH)
Genetic
17
Q
What do the labs for sideroblastic anemia look like?
___ iron
___TIBC
___ ferritin
A
Increased Iron
N/Increased TIBC
increased ferritin
18
Q
What cells are seen with sideroblastic anemia
A
Ringed sideroblasts
19
Q
Tx for sideroblastic anemia
A
Pyridoxine (B6)
20
Q
Pt with anemia, encephalopathy (worse in children), seizures, ataxic gait, WRIST/FOOT DROPS, Dx?
A
Lead poisoning
21
Q
What are Bruton’s lines?
A
Blue gray discoloration seen at gumlines in lead poisoning.
22
Q
What is the classic finding of cells in lead poisoning?
A
basophilic stippling of RBC
23
Q
What is the xray finding of lead posisoning?
A
Lead lines and increased density at the metaphyses of long bones
24
Q
Tx of lead poisoning
A
chelation therapy with dimercaprol (BAL) and or ethylene diaminetetraacetic acid (EDTA)
25
Hereditary disease of decreased production of globin chains causing decreased Hb
Thalassemias
26
How do we differentiate the various thalassemias?
Gel electrophoresis of globin proteins
27
Whats the mechanism of alpha thalassemia?
decreased production of alpha globin chains (4 alleles)
28
What are the 3 most common (in decreasing order) of populations that get thalassemia?
.1 Asian
2. African
3. Mediterranean
29
If 4 alpha alleles are affected, what dz occurs?Blood smear?
hydrops fetalis
fetal demise/total body edema
smear Barts gamma4 Hb
30
If 3 alpha alleles are affected, what dz occurs?Blood smear?
HbH disease
Precipitation of B chain tetramers
Intraerythrocyte inclusions
31
If 2 alpha alleles are affected, what dz occurs?Blood smear?
Alpha thalassemia minor
Clinically silent
Mild microcytic anemic
32
If 1 alpha allele is affected, what dz occurs?Blood smear?
Carrier state
No anemia - asymptomatic
Blood smear not abnormal
33
In beta thalassemia, what 2 populations are most affected?
1. Mediterranean
| 2. African
34
Pt starts developing anemia at age 6mo and has splenomegaly, frontal bossing, iron overload
Thalassemia major
35
How do you dx thalassemia?
Elecrophoresis
36
Why does frontal bossing occur in Beta thalassemia?
secondary to extramedullary hematopoiesis
37
Why does iron overload occur in beta thalessemia?
secondary to transfusions.
38
What are the lab findings for beta thalassemia?
| HbA? HbA2? HbF?
Very decreased HbA
increased HbA2
Increased HbF
39
What is the treatment for thalassemia major?
- Folate
- splenectomy if splenomegaly
- transfuse if severe anemia
40
How does B-thalassemia minor present? Lab findings, Tx?
Asymptomatic
Electrophoresis (same findings as major)
Tx by avoiding oxitative stress
41
What happens to HbS in sickle cell anemia?
HbS tertramer polymerizes causing sickling deoxygenated RBCs
42
Why does vaso-occlusion occur in Sickle cell pts?
Bc blood isn't carrying enough O2, vasoconstriction occurs causing sickled cells to get trapped --> pain crisis.
43
What signs/sx occur because of vaso-oclusion
pain crisis, myocardiopathy
| infarcts of bone/CNS/lungs/kidneys and auto-splenectomy
44
What are sickle cell patients more succeptible to because of autosplenectomy?
Encapsulated bacteria
45
Failure of all types of blood cell growth (aplastic anemia) occurs in sickle cell pts because of what virus?
Parvo virus B19
46
When intravascular hemolysis occurs in sickle cell patients, what is one complication they can develop esp children and teens
Gall stones
47
What is the treatment for sickle cell?
O2 -- transfusion as needed
Hydroxyurea to decrease the incidence and severity of pain crisis
Pneumococcal vaccine bc of increased risk of infection.
48
What is the MCV for megaloblastic anemia?
>100
49
Why do megaloblastic anemias occur?
decreased DNA synthesis with normal RNA/protein synthesis
50
What does the blood smear for megaloblastic anemia look like?
hypersegmented neutrophils
51
What is the most common cause of B12 deficiency?
pernicious anemia
52
What is the mechanism of pernicious anemia?
Antibodies to gastric parietral cells which decreases intrinsic factor (needed for B12 uptake in the terminal ileum)
53
Why does atrophic gastritis occur with pernicious anemia?
Anti-parietal Abs attack parietal cells --> inflammation to stomach mucosa --> grandular tissue is replaced by fibrous tissue --> achlorydia (decreased HCl production)
54
Name 2 other causes of B12 deficiency?
Resection of terminal ileum or diphyllobothrium latum infection.
55
B12 deficiency causes what signs/sx in blood? neuro?
megaloblastic anemia
| neuro signs = peripheral neuropathy, parasthesias, WORSE IN LEGS
56
```
What are the diagnostic lab findings of B12 deficiency?
___ Mehtylmalonic acid
___ Homocystiene
___ B12
___ MCV
```
increased MMA
Increased Homocysteine (more sensitive than b12 level)
Decreased B12
>100 MCV.
57
Tx for B12 deficiency?
High dose b12 (oral proven to be equivalent to parenteral)
58
Where is folic acid derived from?
green, leafy vegetables (foliage)
59
What is the most common reason for folate deficiency?
dietary
60
What two states of the human body increase folate requirement?
Pregnancy or hemolytic anemia
61
What two drugs inhibit folate reduction into tetrahydrofolate?
Methotrexate and prolonged TMP-SMX
62
What symptoms does folic acid deficiency manifest?
Megaloblastic anemia, no neuro signs (unlike B12)
63
Labs for folic acid deficiency?
___ Methylmalonic acid
___ Homocysteine
___ Folate
Normal MMA
Increased homocysteine (more sensitive than folate levels)
May or may not be decreased folate
64
Treatment for folic acid deficiency?
Folic acid oral supplementation
65
What is a normocytic anemia MCV?
between 80 and 100
66
What two categories of normocytic anemia divided into?
hypoproliferative and hemolytic
67
What are the 3 normocytic hypoproliferative anemias?
Anemia of renal failure
Anemia of chronic disease
Aplastic anemia
68
What is the mechanism behind anemia of renal failure?
EPO production is decreased by kidney in chronic renal failure
69
How do you treat anemia of renal failure?
EPO
70
What is the mechanism behind anemia of chronic disease?
Chronic inflammation states like (cancer, TB, fungal, infxn or collagen vascular disease) cause release of hepcidin from the liver as an acute phase reactant so iron is inhibited from gut absorption.
71
What labs can help diagnose anemia of chronic disease?
___Serum iron
___ferritin
___ TIBC
decreased serum iron
normal/increased territin
decreased TIBC
72
What is the mechanism behind aplastic anemia?
Bone marrow failure, usually idiopathic, parvovirus B19, hepatitis virus, radiation, drugs like chloramphenicol
73
How do you dx aplastic anemia? What will bone marrow biopsy show?
Bone marrow biopsy will show hypocellular marrow
74
What are the 4 ways to get hemolytic anemia?
Spherocytosis
Auto immune hemolysis (IgG mediated)
Cold agglutinin disease (IgM mediated)
Mechanical destruction
75
What is the mechanism of spherocytosis?
Autosomal dominant defect in spectrin causes stiff RBCs to be trapped in the spleen
76
What does spherocytosis present with in childhood?
Childhood jaundice and gall stones
77
Which type of bilirubin is elevated in spherocytosis?
Indirect hyperbilirubinemia
78
Is spherocytosis Coombs + or -
negative Coombs
79
What does the peripheral smear for spherocytosis show?
Spherocytes
80
What is the treatment of spherocytosis?
Folic acid and splenectomy for severe disease
81
What is the most common and other causes for autoimmune hemolytic anemia?
Idiopathic (MC)
| lupus, drugs, leukemia, lymphotma (others)
82
Signs and sx of autoimmune helomlytic anemia?
Rapid onset, spherocytes on blood smear
83
Labs seen for autoimmune hemolytic anemia?
____ indirect bilirunin
____ haptoglobin
____urine hemosierin
increased indierct bilirubin
decreased haptoglobin
increased urine hemosiderin.
84
What is the definitive diagnosis for hemolytic anemias?
direct coombs test positive
85
What is the 1st, 2nd and 3rd line treatment for hemolytic anemia?
1st give prednisone
2. Rituximab (anti-CD20 B cell Mab)
3. splenectomy.
86
What is the most commonly idiopathic anemia that could also result from Mycoplasma pneumoniae or Mono (CMV or EBV)
Cold-agglutinin disease (IgM mediated. )
87
Pt gets anemia s/p cold or uri. Dx?
Cold agglutinin disease
88
Dx test for cold agglutinin disease
cold agglutinin test or direct coombs test
89
Tx for cold agglutinin disease
Prednisone, supportive
90
What are the causes of mechanical destruction of RBCs? (4)
DIC, TTp, HUS and artificial heart valve
91
What would be seen on peripheral smear for mechanical destruction?
Schistocytes
92
At what platelet amount does bleeding time increase?
less than 50,000
93
At what platelet amount does clinically significant bleeding start?
less than 20,000
94
At what platelet amount do CNS bleeds start to occur?
less than 10,000
95
What are some causes of thrombocytopenia? (5)
ITP, TTP, HUS, DIC, Drug induced.
96
How does ITP differ in children and adults?
ITP is auto-antibody mediates platelet destruction. In children it occurs after URI and is self-limiting. In adults, its chronic.
97
Whats the treatment for ITP
Steroids, IVIG --> splenectomy --> rituximab (anti CD20) for refractory disease.
98
```
Hemolytic anemia
Thrombocytopenia
Renal failure
Fever
Neurologic disease
is the pentad for what disease?
```
Throbotic thrombocytopenic purpupa (TTP) - often idiopathic and seen in HIV, fatal.
99
What is the Tx for TTP
Tx: Plasma exchange
100
Kid presents with ARF, bloody diarrhea, abd pain, seizures, FULMINANT THROMBOCYTOPENIA w HEMOLYTIC ANEMIA
Hemolytic uremic syndrome (HUS) often bc Ecoli 0157:H7
101
What is the tx for HUS?
Dialysis
102
What are some drugs that can induce thrombocytopenia?
Heparin, sulfonamides, valproic acid --> reversible if agent is stopped
103
What is the most common inherited hypercoagulable disorder?
vWF deficiency (although some places say Factor V)
104
vWF deficiency shows what labs? PT/PTT? BT?
Episodic increased BT
| Normal PT/PTT
105
How do you diagnose vWF?
vWF levels and ristocetin-cofactor test
106
What is the Tx for VWF deficiency? Tx for active bleed?
DDAVP which increased vWF secretion
OR
Cryoprecipitate for active bleed
107
X-linked deficiency of factor VIII
Hemophilia A
108
X- linked deficiency of factor IX
Hemophilia B (aka Christmas disease)
109
What is the major sign/sx for hemophilia?
| Labs? PT/PTT/BT?
bleeding into a joint (hemarthroses)
Increased PTT
normal PT
Normal BT
110
What is the Tx for hemophilia?
Give recombinant Factor VIII or IX concentrate
111
What are 3 myeloproliferative disorders?
Polycythemia vera
Essential thrombocythemia
Idiopathic myelofibrosis
112
What causes myeloproliferative diseases?
Clonal proliferation of myeloid stem cell --> leads to excessive production of mature differentiated myeloid cell lines
113
What is the danger of myelopriliferative diseases?
They can all transform into acute leukemias
114
Pt is a 50-60 yr old MALE with HA, diplopia, retinal hemorrhages, claudication, early satiety, splenomegaly, gout, PRURITIS AFTER SHOWERING, BASOPHILIA
Polycythemia vera
115
Tx for polycythemia vevra
phlebotomy and hydroxyurea
116
Pt with platelet count >1x10^6, splenomegaly and ecchymosis. All other causes like iron deficiency and malignancy were r/o. Dx?
Essential thrombocythemia
117
Tx for essential thrombocythemia?
anagrelide and plateletpharesis
118
Pt >50 yrs old with MASSIVE hepatosplenomemgaly and TEARDROP cells on peripheral smear. Dx?
Idiopathic myelofibrosis
119
What is the prognosis for idiopathic myelofibrosis? What does it progress to?
Poor,
120
What situations can secondary thrombocytosis be seen? Counts often >1 million
Any chronic inflammatory disorder like infxn, bleed, iron deficiency anemia or following splenectomy.
121
What is the most common neoplasm in children (peak age 3-4)
ALL
122
What peripheral blood blasts are seen positive in ALL?
PAS+
CALLA +
TdT +
123
What is the prognosis for cure of ALL in children?
Good, 80%. Much worse in adults.
124
What is the most common leukemia in adults?
AML
125
What blasts are + in blood for AML?
MPO+
Sudan Black +
Auer Rods +
126
What is the Tx for the M3 subtype of AML?
All-trans retinoic acid
127
What complication must we be especially careful about in AML?
DIC
128
Which leukemia presents most commonly in >50yrs old and can result in BLAST crisis within 3-6 mos... though the onset is about 3-4 years?
CML
129
What chromosome is + in serum for CML?
Philadelphia chromosome
130
What is different about the cells in the peripheral blood and what interesting marker does it have?
Peripheral blood has cells of all maturational stages.
Also, decrease in leukocyte alkaline phosphatase.
131
What translocation is the PHL chromosome?
abl gene on chromosome 9 to bcr on chromosome 22
132
Tx for CML
Tyrosine kinase inhibitor like imatinib seylate. If fails, BMT can be curative
133
Pt had this asymptomatic cancer for many years and only recently started to present with organomegaly, thrombocytopenia, hemolytic anemia. Morphology of blood and marrow smear are normal.Tx?
CLL
| Tx: palliative, early tx doesnt prolong life.
134
Which leukemia has a characteristic hairy cell morphology and pancytopenia? Tx?
B cell subtype of hairy cell leukemia
| Tx: INFalpha and splenectomy
135
What type of leukemias generally involve skin and present with erythematous rashes?
T cell leukemias
136
```
MC leukemias by age
15
15-39
40-59
>60
```
15 ALL
15-39 AML
40-59 AMLand CML
>60 CLL
137
Teenage presents with a cancer in head and neck
Non hodgkins lymphoma
138
Which lymphoma is closely related to EBV?
Burkitt's lymphoma
139
African Burkitt's involves which body parts?
| US Burkitts?
African - starry sky
| US- abdomen
140
What's seen on pathology for Burkitts?
Starry sky - spaces scattered within densely packed lymph tissue
141
What is typical therapy for Non Hodgekins?
```
R-CHOP
Rituximab
Cyclophosphamide
Hydroxydaunarrubacine (Adrimycin)
Oncovin (vincristine)
Prednisone
```
142
Elderly pt comes in with diffuse scaly rash or erythroderma (total body erythema). Path report shows stained cells with ceribriform nuclei (cerebral gyri)
Cutaneous T cell lymphoma (CTCL)
| Leukemic phase called Sezary syndrome
143
Treatment of CTCL?
UV light
144
Pt with nasal T cell lymphoma (lethal midline granuloma) and pulmonary angiocentric lymphoma . Large mass, biopsy just shows diffuse necrosis. Tx?
Angiocentric T cell lymphoma
| Tx: palliative radiation, prognosis poor
145
What population does Hodgkins lymphma affect?
Bimodal age distribution, young men and elderly
146
What concurrent infection is present in 50% of cases of Hodgkins?
EBV
147
What type of fevers are present in Hodgkins?
Pel-Ebstein (fevers wax and wane)
148
Pt has Pel-ebstein fevers, chills, night sweats, weight loss, pruritis. What makes these symptoms worse?
Alcohol intake worsens Hodgkins lymphoma sx.
149
What cells are visible on path for Hodgkins
Reed-Stern berg Owl eyes. Binucleated Giant Cells or Mononucleated Giant Cell.
150
What defines each stage of cancer?
Stage 1 = 1 lymph node involvement --> radiation
Stage 2 = >2 lymph nodes involved on same side of diaphragm --> radiation
Stage 3 = Involvement on both sides of diaphragm --> chemo
Stage 4 = disseminated to organs or extranodal tissue--> chemo
151
What are 2 chemotherapy regimens?
```
MOPP = mechlorethamine, Oncovin, Procarbazine, prednisone
ABVD = adriamycin, belomycin, vincristine, dicarbazine.
```
152
For urgent K+ repletion, what to give at what rates?
Give IV 10 mEq/h through peripheral line of 20 mEq/hr through central line
Give oral K simultaneously at upto 40 mEq/hr
153
If you replete K+ too quickly, what is the side effect?
vessel necrosis
154
By how much does each 10 mEq oral or IV increase the total serum K in the body?
Increases serum K by 0.1 mmol/L
155
Peri-MI, K level should be kept above ___ to suppress arrhythmia- be aggressive
>4.0
156
What is the sequence of EKG changes for hyperkalemia?
1. Peaked T waves
2. Diminished R waves
3. Widening of QRS
4. Prolonged PR interval
5. Loss of P wave
6. Sine wave.
look on page 135 for reference.
157
To treat emergent hyperkalemia, why do we give IV calcium gluconate? What do we follow this with?
IV calcium gluconate given to stabilize myocardial cell membranes --> this does not lower potassium.
We then give Glucose + Insulin which will lower the plasma potassium for several hours.
This can be given +/- Kayexalate oral or per rectum to drop K levels for 24 hrs.
158
How much of our lean body weight is water? Where in body is it?
50-70% mostly located in skeletal muscle
159
What fraction of total body water is intracellular and extracecllular?
Intracellular (2/3)
| Extracecllular (1/3)
160
What is the 3 for 1 rule of Fluid management?
Since only 300mL of a 1L lactate ringer solution stays intravascularly, you should replete 3 to 4 times the vascular defecit.
161
In what patients are colloid solutions most useful?
edematous patients because colloid solutions have high molecular weight and stay intravascular for longer
162
What complication could starch solutions have?
Increased tissue accumulation leading to coagulopathy and renal failure.
163
How much fluid does an uncomplicated patient NPO lose per day?
>1 L of fluid from sweat, urine, feces and respiration.
164
How do you know if you are adequately rehydrating a patient?
Urine output > 0.5 cc/kg/hr (for typical patient 30 cc/hr)
165
What is the number 1 cause in inpatients for hypercalcemia?
Malignancy involving bone, parathyroid or kidney
166
What physical exam sign would you see in patients with hypocaclcemia?
Chvostek'sand Trousseau signs
167
What electrolyte disorder would Cushing's often cause?
Hypokalemia
168
What electrolyte disturbance would refeeding syndrome cause?
Hypophosphatemia
169
Explain cascade of thrombus formation starting from endothelial damage?
Endothelial damage --> platelets bind to subendothelium through interaction of von Willebrand factor --> platelets release ADP, 5HT, and platelet derived growth factor --> platelets bind to eachother via GP2b-3a forming thrombus
170
Review Coagulation cascade
Review coagulation cascade
171
Where is vitamin K derived from?
leafy vegetables and colonic flora
172
Which cofactors need vitamin K for gamma-carboxylation
2 7 9 10 factors C and S
173
When is pre-operative lab screening warrented?
Only if there are signs and sx suggestive of underlying bleeding disorder
174
1 unit of packed RBC should raise Hb and hematocrit by how much?
1 g/dL Hb and 3% Hct
175
What is the most common cause of acute rejection of blood products?
clerical error
176
What should be done in case of acute rejection of blood?
stop transfusion and administer IV fluids to maintain urine output.
177
Which hepatitis are you most likely to be at risk for with prior hx of blood transfusion?
Hepatits C
178
What level should platelets be transfused to?
maintain at 50,000 because significant bleeding does not occur unless lower than that
179
What is the most common complication of platelet transfusion?
alloimmunization --> platelet counts continue to fall despite continued transfusion.
180
Why might platelet alloimmunization occur?
Antibodies to donor's MHC (major histocompatibility complex)
181
How to treat pt if platelet alloimmunization is occuring?
Single donor HLA matched platelets
182
Which blood product contains all coagulation factors?
Fresh frozen plasma
183
What is cryoprecipitate rich in?
Factor VIII, fibrinogen and fibronectin.
184
If a uremic patient is having severe bleeding secondary to platelet dysfunction, what to treat with?
DDAVP or cryoprecipitate.... NEVER TRANSFUSE MORE PLATELETS --> they'll just become dysfunctional too
185
How long prior to surgery should asprin be discontinued?
2 weeks
186
What is the most common post operative cardiac event?
Atrial fibrillation
187
What is the most important factor to consider to see if pt is at risk for pulmonary complications post op?
If pt has hx of COPD
188
Azotemia, sepsis, intraoperative hypotension, nephrotoxic drugs and radiocontrast agents all put patient at risk for what?
post operative renal failure
189
What measures can be taken to avoid contrast associated nephropathy (CAN)?
Expand intravascular volume with IV fluids and using N acetyl cysteine or sodium bicarbonate prior to administering radiocontrast dye.
190
What preventative measure must you take pre-op for all pts with prosthetic heart valves?
Give antibiotic prophylaxis to prevent bacterial endocarditis
191
What should always be on the differential of post op dyspnea?
Pulmonary embolus
192
What precaution must be taken for patients on corticosteroids >1 wk preoperatively and with any pt with primary adrenal insufficiency?
Give steroid replacement via hydrocortison before, during and after surgery to approximate response of normal adrenal gland ..
Normal surgical response is to secrete corticosteroids but this response is diminished in pts taking steroids or if they have adrenal insuff.
193
Pt s/p operation has unexplained hypotension and tachycardia despite fluid and vasopressor administration. Tx?
Pt is in adrenal crisis. Give corticosteroids which will dramatically improve BP
194
What is the differential for post op fever in order of post op days?
```
Wind (lungs)
Water (urinary tract)
Wound
Walking (DVT)
Wonder drug (drug reaction)
```
195
What anesthetics trigger malignant hyperthermia? Tx?
halothane, isoflurane, succinylcholine
Treat with dantrolene, cooling measures and ICU monitoring
196
What is the MCC of death in pts
Trauma
197
When surveying the airway, if it cannot be established, what should you do? What do unconscious patients need?
- Use large bore 14 gauge needle insert it into the cricothyroid membrane
- Unconscious pts need endotracheal intubation
198
What does the cxray look like for a tension pneumothorax? Sx? Tx?
contralateral mediastinal shift along with distended neck veins due to increased CVP. Also will have hypotension, absent breath sounds and hyperresonance to percussion on affected side.
Tx: Immediate chest tube or 14 gauge needle puncture of affected side.
199
What is a flail chest a result of? Tx?
Multiple rib fractures, tx: intubation with mechanical ventillation
200
Injury to the great vessels causes what?
massive hemothorax requires chest tube
201
Neck trauma can occur in 3 zones. What imaging is used to assess neck trauma?
look at pic on 150. Use 4 vessel angiography
202
What kind of needles are put in to maintain circulation?
Two large-bore IV placed in upper extremities. For severe shock, place central venous line
203
What is the indication for a FAST exam?
intraperitoneal hemorrhage or pericardial tamponade
History of abdominal trauma, hypotensive or unable to provide a reliable history because of impaired consciousness due to head injury or drugs.
204
What are the 4 areas assessed with a FAST exam?
1. Periherpatic (hepatorenal space)
2. Perisplenic
3. Pelvis
4. Pericardium
205
What is the DDx for loss of consciousness?
```
Alcohol
Epilepsy
Insulin
Overdose
Uremia
```
Trauma
Infection
Psychogenic
Stroke
206
What is the Tx for LOC in an emergent situation where cause is unknown
Tx: coma cocktail --> dextrose, thiamine naloxone and O2
207
What is Cushing's triad?
HTN, bradycardia and bradypnea seen when there is increased ICP
208
Tx for Pt with "Disability" including Cushings triad and increased ICP?
Ventillation to keep PaCO2 at 30-40 mm Hg, control fever, administer mannitol, corticosteroids and even bony decompression if needed
209
What does ABCDE stand for in trauma situations?
```
Airway
Breathing
Circulation
Disability
Exposure
```
210
What do racoon eyes and Battle's sign indicate?
Periorbital and mastoid hematomas
211
If blood is noted at the urethra, what must be done before placing a bladder catheter?
retrograde urethrogram
212
What is hematuria s/p trauma suggest?
significant retroperitoneal injury
213
What happens to the pulmonary capillary wedge pressure in cardiogenic shock?
increased PCWP
214
What is the treatment for compartment syndrome?
Fasciotomy
215
What is the defect and tx for hypovolemic shock?
decreased preload -- 2 large bore IVs with crystalloid infusions 3 for 1 rule
216
What is the defect and tx for cardiogenic shock?
Myocradial failure -- Pressors dobutamine is first line
217
What is the defect and tx for septic shock?
Decreased peripheral vascular resistance -- Give norepinephrine to vasoconstrict peripheral arterioles to prevent multiple organ dysfunction syndrome (MODS)
218
```
Which layer of dermis do the following burns affect?
1st deg
2nd deg
3rd deg
4th deg
```
1st deg superficial dermis
2nd deg epidermis
3rd deg skin and subQ tissue
4th deg affects muscle and bone
219
How do you calculate the percentage of Body surface affected? (BSA)
See image on p 155
220
How do you calculate and administer fluid resuscitation to a burn victim? How is it given?
Parkland fomula = %BSA * weight (kg) * 4
Used to calculate amount of crystalloid needed
Give half of fluid in the first 8 hours and give the remainder over the next 16 hours
221
Why is it important to make burn patient NPO?
must have return of bowel function
222
What are the nutritional requirements of a burn pt?
High protein and caloric requirements with vitamin supplementation.
223
What is a Marjolin's ulcer?
squamous cell carcinoma arisng from an ulcer or burn
224
What is a Curling's ulcer?
acute duodenal ulcer seen in burn patients
